130 DR. ARTHUR RANSOME ON THE 



At the risk of sacrificing even this small tribute to the 

 value of sanitary work, I must, however, point out that 

 this restriction of the term '' preventible " is not usually 

 recognized by the medical profession. The sanitarian claims 

 much more than epidemic diseases as truly preventible. 

 The influence of favourable or unfavourable sanitary 

 conditions is also plainly shown in such cases as phthisis, 

 diarrhoea and dysentery, scrofula, various pulmonary com- 

 plaints, convulsive disorders, and, to some extent, in the 

 whole range of diseases that produce our excessive infant- 

 mortality. The true meaning of the term " preventible " 

 mortality is fully given by Mr. Simon in his preface to Dr. 

 Greenhow's Inquiry. Briefly stated, it means " all local 

 excesses of fatality that are due to local circumstances of 

 aggravation^' (p. viii). 



The excessive mortality from a large group of diseases 

 other than epidemic in their character may then be greatly 

 diminished, partly by public sanitary work, and still more 

 by improvements in domestic hygiene amongst the poor — 

 such as sanitary associations and medical ofiicers of health 

 may by degrees be able gradually to teach. 



It may fairly be asked , then, of sanitarians, where is the 

 proof of your ministry ? 



The range of preventible mortality is greater than Mr. 

 Baxendell supposes ; but it has not been prevented. To 

 what must this result be attributed ? Mr. Baxendell seems 

 inclined to question the utility of the costly sanitary works 

 that have been undertaken of late years ; but an examina- 

 tion of the local details that make up the total mortality 

 will soon show that in places where these works have been 

 thoroughly carried out a very distinct efiect upon the 

 mortality has been produced, and that the stationary condi- 

 tion of the total death-rate is mainly caused by the increas- 

 ing mortality in places that have not been thus cared for. 



